Explaining the SES/Overweight and Obesity Relationship

解释 SES/超重和肥胖的关系

• 批准号: 8246131
• 负责人: SHIRLEY AA BERESFORD
• 金额: $ 9.3万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-03-01 至 2014-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8246131
• 关键词: Age; Attention; Behavior; Biological Factors; Body Image; Body Weight Changes; Body mass index; Cardiovascular Diseases; Caucasians; Caucasoid Race; Chronic; Complex; Country; Data; Developed Countries; Diabetes Mellitus; Disease; Eating; Ethnic Origin; Family; Food; Health; Height; Hispanics; Household; Hydrocortisone; Individual; Intervention; Life; Link; Malignant Neoplasms; Mediating; Modeling; Moods; Neighborhoods; Not Hispanic or Latino; Obesity; Output; Overweight; Pathway interactions; Pattern; Physical activity; Play; Prevention program; Process; Resources; Risk Factors; Sleep disturbances; Socioeconomic Status; Stress; Testing; Time; Weight; Weight Gain; Woman; Women' s Role; base; behavior change; cohort; cost; high risk; improved; intervention program; low socioeconomic status; member; men; middle age; obesity prevention; obesity risk; population based; psychologic; psychosocial; social; socioeconomics; urban area

DESCRIPTION (provided by applicant): Obesity occurs disproportionately in women of lower socioeconomic status (SES), especially in industrialized countries. Rising rates of obesity have been linked to higher rates of cardiovascular disease, cancer, diabetes, and other chronic and life threatening diseases in both men and women. Weight gain in women during middle age (age 30-50) is frequent and of particular concern because of the consequences for later health and because of the important role these women play in their households. Among Hispanics, higher rates of obesity are associated with higher SES, similar to what has been found in poorer countries, historically. Most obesity prevention programs based on individual behavior change have not been successful in achieving long-term healthy weight. Attention is shifting to more complex environmental and societal contributions to adiposity, including central adiposity, to help identify multi-level and multi-causal pathways and to target interventions to high risk groups. Improved understanding is needed of the mechanisms by which established risk factors for increased body mass index (BMI) operate along the SES gradient (inverse for Caucasians, and positive for Hispanics). The main aim of this project is to better understand and evaluate the putative causal pathways between SES and BMI in middle-age women. Data from this project would assist in reducing the number of intervention channels and provide clues on how to reach these women and their household members to influence weight change through the mechanisms that mediate the SES disparities in risk of obesity. Ultimately, excess weight is caused by energy imbalance, with higher caloric input than output. However why this should occur at different rates according to different levels of SES is not known. We shall test key explanations for the SES and overweight/obesity relationship in a population-based cohort of 1000 women age 30-50, with oversampling of Hispanic women in a major urban area, based on a conceptual model by Mackenbach.1-3 By augmenting the recruitment to enhance the representation of women of Hispanic ethnicity, we will be able to conduct analyses within the group who are non-Hispanic white and separately, within the group who are of Hispanic origin. Specific aims are as follows: 1. To evaluate the mediating cross-sectional effects of a) material resources (e.g., walkability of neighborhood, availability of healthy foods; cost of food); b) psychosocial context (e.g., body image, norms of family and culture);and c) stress process (e.g., mood, sleep disturbance, cortisol) in the relationship between SES, weight-related behaviors (physical activity & eating patterns) and BMI in middle-age women 2. To evaluate the relationship between SES and change in weight over a 3-year period 3. To evaluate longitudinally the mediating effects of material resources, psychosocial context, and the stress process in the relationship between SES, BMI and central adiposity in middle aged women. PUBLIC HEALTH RELEVANCE Possible explanations for the observation that gradients over time in increased weight for height differ according to socioeconomic status are not well understood, and may differ by ethnicity or other socio- cultural factors. We propose, in middle aged Caucasian and Hispanic women, to study mechanisms including social, psychological, and biological factors, and the intersection of these factors in explaining the observed associations of obesity risk with socioeconomic status. Data from this project would assist in reducing the number of intervention foci and provide clues on how to reach these women and their household members to influence weight change through the mechanisms that mediate the socioeconomic disparities in risk of obesity.

描述（由申请人提供）：肥胖在社会经济地位（SES）较低的女性中比例较高，尤其是在工业化国家。肥胖率上升与男性和女性心血管疾病、癌症、糖尿病以及其他慢性和危及生命的疾病的发病率升高有关。中年时期（30-50 岁）女性的体重增加很常见，并且特别令人关注，因为这会对以后的健康产生影响，而且这些女性在家庭中发挥着重要作用。在西班牙裔中，较高的肥胖率与较高的社会经济地位相关，这与历史上较贫穷国家的情况类似。大多数基于个人行为改变的肥胖预防计划并未成功实现长期健康体重。人们的注意力正在转向更复杂的环境和社会对肥胖的影响，包括中心性肥胖，以帮助确定多层次和多因果途径，并将干预措施针对高风险人群。需要更好地了解体重指数 (BMI) 增加的既定风险因素沿着 SES 梯度（对白种人呈负数，对西班牙裔呈正数）起作用的机制。该项目的主要目的是更好地理解和评估中年女性 SES 与 BMI 之间的假定因果关系。该项目的数据将有助于减少干预渠道的数量，并提供线索，说明如何影响这些妇女及其家庭成员，通过调节社会经济地位肥胖风险差异的机制来影响体重变化。最终，体重过重是由于能量不平衡造成的，热量输入高于输出。然而，为什么这种情况会根据不同的社会经济地位水平以不同的速度发生尚不清楚。我们将根据 Mackenbach 的概念模型，在一个由 1000 名 30-50 岁女性组成的人口队列中测试对社会经济地位和超重/肥胖关系的关键解释，并对主要城市地区的西班牙裔女性进行过采样。1-3 通过扩大招募以提高西班牙裔女性的代表性，我们将能够在非西班牙裔白人和非西班牙裔女性群体中进行分析。 分别在西班牙裔群体中。具体目标如下： 1. 评估 a) 物质资源（例如，社区的步行性、健康食品的可用性、食品成本）的中介横截面效应； b) 社会心理背景（例如身体形象、家庭和文化规范）；c) 中年女性 SES、体重相关行为（身体活动和饮食模式）和 BMI 之间关系的压力过程（例如情绪、睡眠障碍、皮质醇） 2. 评估 3 年期间 SES 与体重变化之间的关系 3. 纵向评估物质资源、心理社会因素的中介作用 中年女性SES、BMI与中心性肥胖关系的背景、压力过程。公共卫生相关性 对于随时间推移体重与身高增加的梯度因社会经济地位而异这一观察结果的可能解释尚未得到充分理解，并且可能因种族或其他社会文化因素而异。我们建议，在中年白人和西班牙裔女性中，研究包括社会、心理和生物因素在内的机制，以及这些因素的交叉点，以解释观察到的肥胖风险与社会经济地位的关联。该项目的数据将有助于减少干预焦点的数量，并为如何接触这些妇女及其家庭成员，通过调节肥胖风险的社会经济差异的机制来影响体重变化提供线索。